Mammostrat
➤ If a patient has ER/PgR-positive, HER2-negative (node-positive or
node-negative) breast cancer, the clinician should NOT use the five-
protein assay (Mammostrat; Clarient, a GE Healthcare company, Aliso
Viejo, CA) to guide decisions on adjuvant systemic therapy. (Moderate
Recommendation; EB-I)
➤ If a patient has HER2-positive breast cancer or TN breast cancer, the
clinician should NOT use the five-protein assay (Mammostrat) to guide
decisions on adjuvant systemic therapy. (Strong Recommendation;IC-Ins)
Immunohistochemistry 4 (IHC4)
➤ If a patient has ER/PgR-positive, HER2-negative (node-positive
or node-negative) breast cancer, the clinician should NOT use
immunohistochemistry 4 (IHC4) to guide decisions on adjuvant systemic
chemotherapy. (Moderate Recommendation; EB-I)
➤ If a patient has HER2-positive breast cancer or TN breast cancer, the
clinician should NOT use IHC4 to guide decisions on adjuvant systemic
therapy. (Strong Recommendation;IC-Ins)
Urokinase Plasminogen Activator and Plasminogen Activator
Inhibitor Type 1
➤ If a patient has ER/PgR-positive, HER2-negative (node-negative) breast
cancer, the clinician may use urokinase plasminogen activator and
plasminogen activator inhibitor type 1 to guide decisions on adjuvant
systemic therapy. (Weak Recommendation; EB-H)
➤ If a patient has HER2-positive breast cancer or TN breast cancer,
the clinician should NOT use urokinase plasminogen activator and
plasminogen activator inhibitor type 1 to guide decisions on adjuvant
systemic therapy. (Weak Recommendation; IC-Ins)
Circulating Tumor Cells
➤ The clinician should NOT use circulating tumor cells to guide decisions
on adjuvant systemic therapy. (Strong Recommendation; EB-I)
Tumor-Infiltrating Lymphocytes
➤ If a patient has ER/PgR-positive, HER2-negative (node-positive or node-
negative) breast cancer, the clinician should NOT use tumor infiltrating
lymphocytes to guide decisions on adjuvant systemic therapy.
(Strong Recommendation; IC-Ins)
➤ If a patient has HER2-positive breast cancer or TN breast cancer,
the clinician should NOT use tumor-infiltrating lymphocytes to guide
decisions on adjuvant systemic therapy. (Strong Recommendation; EB-I)
